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Ehr models, standards and semantic interoperability

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Ehr models, standards and semantic interoperability

  1. 1. EHR models, standards and semantic interoperability David Moner damoca@veratech.es ELECTRONIC HEALTH RECORDS: A VIEW AT THE CURRENT DEVELOPMENTS OF HEALTHCARE DELIVERY MODELS IN POLAND AND THE EU / ELEKTRONICZNA DOKUMENTACJA MEDYCZNA W POLSCE I EUROPIE THE NATIONAL E-HEALTH CLUSTER CONFERENCE ZAMEK TOPACZ, 6-7 AUGUST 2015
  2. 2. An interoperable world • Technology allows us to be connected and to have access to our data everywhere at every time. Why is this not true with health information? EHR models, standards and semantic interoperability 2
  3. 3. Medicine vs. Medical Science • In some aspects, medicine is still evolving towards becoming a complete science. – Other sciences, such as Mathematics, use common models and notations since the XVI century. EHR models, standards and semantic interoperability 3
  4. 4. Medicine vs. Medical Science Physiological and biological systems Clinical reasoning & decisions Health observable data Virtual Physiological Human Clinical information models and terminologies Clinical decision support systems and clinical guidelines EHR models, standards and semantic interoperability 4
  5. 5. Electronic Health Records • The Electronic Health Record (EHR) is the main source of information of health organizations. – It is a complete electronic registry of all events and data related to the health status of a person, from birth to death. It enables an efficient management of clinical information EHR models, standards and semantic interoperability 5
  6. 6. Hospital 1915 Hospital 2015 EHR models, standards and semantic interoperability 6
  7. 7. Electronic Health Records • The Edwin Smith papyrus is one of the oldest medical documents (1600 BC). • For a computer, it is as incomprehensible as any other current document. EHR models, standards and semantic interoperability 7
  8. 8. Electronic Health Records • We need to have models for the EHR (clinical information models). EHR models, standards and semantic interoperability 8
  9. 9. Modeling the EHR • A model is an abstract representation of systems, processes and data that helps in interpreting and implementing them. – It is a reference to be followed to build (EHR) information systems. EHR models, standards and semantic interoperability 9
  10. 10. Modeling the EHR • But… does the “right” model exist? © Linda Bird, MOH Holdings EHR models, standards and semantic interoperability 10
  11. 11. Modeling the EHR • The problems we are facing are: – Health data is complex. – Health data is variable. – Health data has specific semantics. How can we agree on common formats and models? How can we share our data and reuse other’s data? EHR models, standards and semantic interoperability 11
  12. 12. Modeling the EHR • It is not about creating and using a single and universal EHR system for everybody. EHR models, standards and semantic interoperability 12 Finally standardization was achieved…
  13. 13. Modeling the EHR • We need to create models that are semantically interoperable. – Semantic interoperability is the ability of sharing, aggregating, analyzing and using external information automatically and in a meaningful way. 00100101110 EHR models, standards and semantic interoperability 13
  14. 14. EHR models, standards and semantic interoperability 14
  15. 15. Modeling the EHR SYSTEM A SYSTEM B Health information Structure A Model A Language A Structure B Model B Language B Context A Context B ? Reference Model Clinical inf. models Terminology EHR models, standards and semantic interoperability 15
  16. 16. Modeling the EHR • A Reference Model provides the syntax (basic data structure and data types) to represent any kind of health information in the EHR. EHR models, standards and semantic interoperability 16
  17. 17. Modeling the EHR • How can we avoid building a nonsense? EHR models, standards and semantic interoperability 17
  18. 18. Modeling the EHR • We need blueprints or guides that define the specific configuration of the EHR information. – Clinical information models or archetypes EHR models, standards and semantic interoperability 18
  19. 19. Modeling the EHR Real data Archetype (a model of data structures with an specific meaning) EHR models, standards and semantic interoperability 19
  20. 20. Modeling the EHR • Standards such as ISO 13606 for the communication of the EHR, or the openEHR specifications provide both a reference model and an archetype model. + EHR models, standards and semantic interoperability 20
  21. 21. Modeling the EHR • We have libraries of archetypes ready to be used. E.g. http://www.openehr.org/ckm/ EHR models, standards and semantic interoperability 21
  22. 22. Modeling the EHR • It is not enough to have a reference model and archetypes, we need another piece: terminologies. – They provide the semantic description of the data and the models. – They provide a subset of possible data values (e.g. the set of possible diagnosis or allergies). EHR models, standards and semantic interoperability 22
  23. 23. Modeling the EHR 25571000000103 (Discharge report) SNOMED-CT 85097005 (Secondary diagnosis ) … 89100005 (Final diagnosis - discharge) EHR models, standards and semantic interoperability 23
  24. 24. Modeling the EHR EHR models, standards and semantic interoperability 24 Referencemodel Archetypes Terminologies Semantic interoperability
  25. 25. Modeling the EHR Semantically interoperable data Reduce healthcare costs Improve healthcare (availability of data) Inclusion of personal clinical data (PHR) Clinical research Big data and Linked data Right data (quality of data) … EHR models, standards and semantic interoperability 25
  26. 26. From theory to practice Technical University of Valencia, Spain ITACA Institute Biomedical Informatics Group (IBIME) • Spin-off SME company created in 2010. • Mission: to offer solutions and technologies for clinical data integration, standardization, analysis and reuse. www.veratech.es EHR models, standards and semantic interoperability 26
  27. 27. From theory to practice EHR models, standards and semantic interoperability 27 Reuse
  28. 28. • LinkEHR Normalization Platform – A set of tools that facilitates the adoption of EHR standards based on the use of archetypes. – It works over existing EHR systems and data. EHR models, standards and semantic interoperability 28 www.linkehr.com Reuse
  29. 29. • Four main modules: – LinkEHR Integration: distributed data integration engine. – LinkEHR Editor: reference model independent archetype editor. – LinkEHR Studio: transformation of existing legacy data into archetype-compliant standardized data. – Clinical Information Model Manager: management and government of clinical models and archetypes. EHR models, standards and semantic interoperability 29 Reuse
  30. 30. • Spanish National EHR System – Provides access to a patient summary and to the most relevant clinical documents of the patients from 17 different regions. – 8 documents have been modeled as ISO 13606 archetypes using LinkEHR Editor. EHR models, standards and semantic interoperability 30 www.msssi.gob.es/profesionales/hcdsns • Population: 46 M • Tourists: ~65 M/year Reuse
  31. 31. EHR models, standards and semantic interoperability 31 Concept management system developed by VeraTech Reuse
  32. 32. • Clinical Document models for the National Unified EHR – The objective is to provide support for continuity of care. – 9 documents are being modeled as HL7 CDA archetypes using LinkEHR Editor. EHR models, standards and semantic interoperability 32 • Population: 3.3 M Reuse
  33. 33. • Shared EHR system (Madrid region, Spain) – Objective: to build an EHR system based on ISO 13606 and archetypes for 5.5 million people. – Fed by existing primary and specialized care EHR systems. Data will be transformed using LinkEHR Studio. – The challenge is to maintain the relationships between all the information. EHR models, standards and semantic interoperability 33 Reuse
  34. 34. EHR models, standards and semantic interoperability 34
  35. 35. • Around 80% of clinical data has quality problems. • We are developing a web service to automatically evaluate several quality dimensions: unicity, correctness, consistency, temporal stability… Qualize (VeraTech) Data quality automatic evaluation service. (Public Beta available in October 2015) EHR models, standards and semantic interoperability 35 Reuse
  36. 36. • Archetype-based data warehouse environment – Development of an integrated process for the modeling, extraction, transformation and load (METL) of existing health data into an archetype- based data repository. – Oriented to facilitate the reuse of health data. EHR models, standards and semantic interoperability 36 Reuse
  37. 37. EHR models, standards and semantic interoperability 37 LIS Transformation Legacy XML openEHR compliant data openEHR data repository (Marand Think!EHR) Guide queries Applies transformation and aggregation rules Archetypes Define data structures Edits Archetype-based data warehouse environment to enable the reuse of electronic health record data Luis Marco-Ruiza, David Moner, José A. Maldonado, Nils Kolstrup, Johan G. Bellika International Journal of Medical Informatics 84 (2015) 702–714 Reuse
  38. 38. • In Assisted Human Reproduction a multiple pregnancy is a severe problem due to premature births, low birthweight babies and obstetric problems. • A Decision Support System was developed to help in deciding how many embryos needed to be transferred. – 8% decrease in multiple pregnancy after the 6 first months. Valencian Institute of Infertility Each year it helps around 5,000 couples from 80 countries in search of treatment in reproductive medicine. EHR models, standards and semantic interoperability 38 Reuse
  39. 39. Conclusions EHR models, standards and semantic interoperability 39 Reference model Archetype Archetype- based data repository Original data Data reuse Describes Guides transformations Guides queries +
  40. 40. Conclusions (for SMEs) • Success comes from solid foundations, long term vision of needs and applied technology and solutions for existing problems. EHR models, standards and semantic interoperability 40
  41. 41. Thank you! Questions? David Moner damoca@veratech.es

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